Tuesday, August 25, 2009

Being self pay in an insurance world

I've recently had a discussions with my friends about health insurance so I figured I'd let you all in on how my side of the conversation goes.

We don't have any insurance. Zip. None. Nada.

Why not? Hubby owns his own business and is the only employee. We would wind up spending WAY more on insurance than what we pay on medical bills. That includes the five children we've had.

How is this possible? No, we're not rolling in money so check that off your list. We're just a typical American family, except we've have twice the average 2.5 kids that the typical American family has. We've simply discovered a way around the system quite by accident.

When we had our 15 year old, Kelly, we were young, broke, college students. Fortunately we had a lot of help from our families. The hospital bill alone was $4,5000. Keep in mind, this was not a normal birth. I had complications and had to stay four days instead of the usual two. Kelly was released after two days but when they told Hubby he could take her home, he looked at them and laughed. So she stayed in my room. Because we were "self pay," when we got the bill we went through it with a fine toothed comb. They charged us four days in the nursery instead of two. There were a few other charges that weren't correct and when we called the hospital, they gladly took the charges off.

The next baby was completely different. The pregnancy was normal until my 7th month when I went into labor early. We had test after test for two months before Jacob was diagnosed with Trisomy 18. Had we had insurance, the bill would have been astronomical. We had several advanced ultrasounds, one with five doctors from five different specialties all in the same room. We had an amniocentesis, appointments with a geneticist, plus six visits to the ER to receive a shot to stop my labor. I have no idea what our bill would have been if we'd had insurance. Our OB/GYN gave us a discount because we paid in cash. The hospital removed several charges because we paid cash. Our geneticist didn't charge us at all. We received a severe discount on the amnio. And the brand new advanced ultrasound performed with the team of doctors? Free. Yes, a lot of this was because they felt sorry for us that our son would not live long even if he made it through delivery. But many of the discounts were due to the fact the hospital/doctors didn't have to wade through mounds of paper work and wait months to be reimbursed by some over inflated medical insurance company. They were getting cash without having to bill us.

We used the same doctor's office when I got pregnant with Reyna. They continued to be wonderful giving us a discount once again. We even got a discount on the amnio which thankfully came back normal. After having Jacob it was highly suggested we get an amnio for every pregnancy to screen for chromosomal disorders. We did use medicare in my last two months of pregnancy with Reyna. She was our first baby born in Florida where the other two were born in North Carolina. The previous seven months, we paid cash to our doctors in North Carolina. We used Florida Kid Care for Reyna and Kelly until we moved back to NC a year later. So, for a short time, we accepted help from the government. They tried each time we went into the office to push food stamps on us. We were perfectly capable of providing our family with groceries and continually declined. Others are greedy and will take whatever the government offers them whether they need it or not. We didn't feel comfortable taking advantage of the system.

The pediatrician in NC that we used for the girls gave us a discount because we paid in cash. If they needed a prescription, they looked through their samples first before writing one we'd have to pay for.

We looked into insurance when we decided to have another baby. We would have had to wait up to two years before I could get pregnant. I wanted a baby now. When
I wanted one. I didn't want some money hungry company telling me when I was allowed to expand my family. So we opted to not get insurance. When we finally got pregnant with Carson, we used a doctor's office that was highly recommended. It was crap. The whole experience was horrible. They treated me like trash because I was self pay, though they did give us somewhat of a discount. When we hit a snag for two months and were unable to pay them, they told me I would have to go to the Health Department for the last two months of my pregnancy. We paid them as soon as we could, refusing to go anywhere else. We paid cash for my epidural and received a discount.

Oh, and sometimes it's all in who you know. We paid in advance for a private room. One was not available after I was finished in the delivery room, so I was placed in a room with a horrible couple who apparently didn't care that I could hear everything they said on the other side of the paper thin curtain. They spoke, loudly, of how bad their last experience was when the mother had to share a room. My visitors could hear them. Both of our nurses could hear them. Their nurse apologized several times. I couldn't take it anymore and started to cry. I looked at Hubby and pleaded with him to take me home. He grabbed someone out in the hall, told them who he knew in the higher ups of the hospital, and I was quickly whisked off to a private room and given a steak and shrimp dinner compliments of the hospital. The other couple's nurse even found me and apologized again. The day Carson and I were released from the hospital, billing called up to my room and asked if Hubby could come down and speak with them. They told him if he paid the whole bill right then, they'd cut it in half. Yup, in HALF! Which, by the way, had nothing to do with who we knew. They'd rather be paid something right then, then have to waste paper and time billing us over the next several months and not know whether or not they'd get paid.

We had the same experience when I had Maisie (though we chose a different doctor's office and they were phenomenal). Cha ching, discount from the doctor. Cha ching, discount from the ultrasound specialist. Cha ching, discount from the hospital. We even got a discount for my tubal ligation. Yes, we're finished. Even though Carson has been begging for a little brother. I told him, "Tough luck. I'm done."

Our family doctors do the same thing for us. I tell them we're self pay, the doctor himself writes how much he's charging us on our chart. If they have samples, they give them to us.

We've been very fortunate and have had healthy kids aside from Jacob. They have an occasional sinus infection, injury, yearly check ups, and sports physicals, but we pay MUCH less out of pocket than we would paying for insurance every month. I noticed that our family doctor's office has started asking for co-pays before patients see the doctor. With us, we get charged after we see him. Sometimes we make a partial payment and are billed for the remainder. They always get paid and without all the headaches and hoops they have to jump through with insurance companies. We can see what ever doctor we choose. We don't need to get referrals. If we do have to go to the ER, we don't have to check and make sure the doctor that sees us is covered by our insurance plan. If we are unable to make the payments, we can't lose out cars. They can't take our house. They can't garnish wages. They must accept the loss. Would I feel bad not paying for the service I received? Yes. But I wouldn't move my family out on the street because I was unable to pay for a severely overinflated medical fee either.

After sharing the above with people, I always get the same reaction. Their jaws hit the floor and they are speechless. When they are finally able to form words again, the first question they ask is "In half?" Most people are unaware of how much money the insurance companies are making and how much they overcharge. Once upon a time, there was no health insurance. Office visits didn't cost $100. It didn't cost $10,000-$30,000+ to have a baby. Surgeries and ER visits didn't put you in financial shock. I shared this with my friends and some are now rethinking paying for insurance.

I've recently began to look into catastrophic insurance a little bit.

The following is from Catastrophic Health Insurance

Everyone knows how important it is to have health insurance, but what about coverage for events such as a bicycle or auto accident, dog bite, appendectomy or emergency root canal? These events are unpredictable, traumatic and expensive since they often require an emergency room visit. Below are the estimated costs of a selection of emergency treatments and surgeries:

Minor Car Accident: $15,082
Major Car Accident: $814,251
Appendectomy: $15,850
Severe Dog Bite: $4,622 - $6,842
Broken Limb: $1,000 - $2,000
Root Canal: $1,000

A catastrophic plan from Blue Cross Blue Shield of Florida for a nonsmoking 21-year-old female, with a $250 deductible and $2,500 out-of-pocket limit after exceeding the deductible, costs $29 per month.

This is something I may look into sometime but for the time being we're perfectly content being self pay.

1 comment:

  1. thanks for sharing kayti! i too not taken any health insurance.